A 72-year-old male in HD program from December 2002 due to renal failure secondary to bilateral nephrectomy for renal neoplasia (1999 and 2002).
History of arterial hypertension, cystectomy, cholecystectomy and right inguinal hernia.
Cholecystectomy due to a bulla injury during right nephrectomy (2002).
Venous thrombosis in the right lower limb conditioned by femoral cannulation (dialysis catheter).
Ischemic colitis, colon polyposis and lower gastrointestinal bleeding in 2007.
In December-08 new episode of lower gastrointestinal bleeding due to angiodysplasia.
He was diagnosed in 2009 with moderate-severe aortic valve stenosis.
History of vascular access:
• Started treatment in December-02 with a right femoral catheter.
It was removed in February-03 (venous thrombosis).
• In January-03 he practiced a left atrial fibrillation.
It started at 4 weeks.
He developed an aneurysmal dilatation, presenting a partial thrombosis (male-03), which allowed its use in a single injection.
• In December-03 a right FAVI ̈ ̈ © 2012 Sociedad Colombiana de Anestesiología y Reanimación.
• In the same month, a right PTFE-hilar type graft was implanted, with thrombosis at 24 hours.
He had to be removed due to infection in January-04.
• Due to left fistula dysfunction, a tunnelled catheter was implanted in the left internal jugular in January-04.
It was used as VA until July-04, with removal due to infection refractory to antibiotic therapy.
• 22-7-04 there was a failed attempt to canalize the right internal jugular, placing a catheter in the right femoral vein: it was removed in sep-04, when a functioning AVF was available.
• Again, the 23-7-04 attempt was made to cannulate both the right and left internal jugular unsuccessfully.
• A PTFE prosthesis was implanted between the left femoral artery and vein on 4-8-04th day.
It was used from September to 22-10-04 (non-reusable thrombosis).
• On the same day 22-10-04 a tunnelled catheter was implanted in the right internal jugular:
- An episode of E. Coli bacteremia resolved with antibiotic therapy in October 2005.
- The catheter subsequently caused insufficient flow problems, often requiring local and systemic fibrinolytic treatment.
- For this reason, in November-06 anticoagulation with acenocoumarol (Sintrom®) was indicated, with mild functional improvement.
- In February-07 he suffered an episode of lower gastrointestinal bleeding due to ischemic colitis and colonic colitis conditioned by anticoagulant treatment.
- After removing acenocoumarol, the catheter stopped flowing.
- On 22-2-07, an attempt was made to replace the catheter through the same venous tract, making it impossible to introduce the new catheter due to complete thrombosis of the superior vena cava.
• On the same day 22-2-07, a temporary catheter was placed in the left femoral vein.
2-3-07 was removed when a functioning central catheter was available.
• On the 28-2-07, a tunnelled Split-Cath catheter was placed directly into the right atrium using a right anterior mini-thoracotomy.
- From the first dialysis session there was minimal blood leakage through the catheter connection ports.
It was not an impediment to continuing to treat him.
- Hospitalisation in October-07 due to catheter infection resolved with antibiotics.
- In November-07 there was a significant increase in blood leakage, with placement of a sterile silicone seal and placement of a PTFE silicone around the puncture site.
- In March 2009 the blood leak resolved with the same sealed procedure and returned PTFE.
- A new sealing attempt failed again on 30-11-09.
• 22-3-09 required insertion of a temporary catheter in the right femoral artery for a few days.
• On December 17, 2009, a new transthoracic dressing change was performed, and another Split-Cath catheter was placed.
- As a complication, she developed cardiogenic shock after surgery, and was then diagnosed with moderate to severe aortic valve stenosis.
- The catheter showed inadequate flow, with distal ends located in the suprahepatic vein.
- 25-3-10 was replaced with haemodynamics, the distal ends of the catheter being placed in the inferior vena cava.
- 24-9-10, again due to catheter dysfunction, was repositioned in hemodynamics, with distal ends lodged in the right atrium.
• A temporary right femoral catheter was inserted in 22-3-10 for a few days.
Since the last episode of day 24-9-10 and to date (10-02-2012), the patient is dialyzed in his dialysis center by transthoracic catheter, with no incidents and adequate catheter function.
